Study Favors Chiropractic over Surgical Discectomy for Sciatica

 I recently came across a study in the JMPT (Journal of Manipulative Therapeutics) regarding Maniopulation (mostly done by chiropractors) Vs. Microdiscectomy (micro dissection surgery) that is becoming very common and has quick recovery times.  There are many times I see patients going to their doctor and having tests such as MRI done and then waiting for the dreaded decision.  As many of you know, we often resolve back problems before MRI is required and before a referral is ever needed. The fact is, often, our care costs less than the MRI.  The reality is that the way we walk (gait) determines the way we function and also determines our likelihood in developing a herniated disc requring surgery in the first place.  Even though the study shows outcomes are similar between manipulation and microdiscectomy, the overall management of the gait issue assures a much better outcome thant manipulation or surgery.
    I have had many people avoid surgery with our approach.  I often see people who are in severe pain make rash decisions when they are irritable and scared like visiting the emergency room for back pain or immediately undergoing an MRI and taking pills that do not improve function.  For Sciatica, see us first.  You will get better faster, more safely, with less intervention with care centered on long term resolution of your problem, rather than just the symptom of back pain.

Macro vs.Micro - Getting to the source of your problems

     Do you see your problems with your body as the big picture or from a small point of view.  This is something I have discussed with many of our patients because it is how we are able to get superior results in solving many peoples problems.  Many doctors see the micro, meaning your elbow hurts while playing tennis, so lets look at the elbow and treat it, or the person who has knee pain and your doctor as well as you are obsessed with treating that problem.  Over the years, I have learned never to take things at face value when it comes to mechanical problems in the body.  Doing so assures expensive care that frankly is usually ineffective. Looking at the micro makes us miss what is really happening in your body.  Obsessing about the herniated disc and treating it as if it created itself because things just happen is fooling ourselves and setting you up for years of exacerbations and even surgeries.
    I look at the macro or the big picture because this is where you find the cause of peoples problems, looking past the obvious.  A great example of this is a tennis player I saw this weekend.  We started with some elbow, shoulder and flexibility issues which have markedly improved.  This weekend, she said she still felt some elbow pain however,   the ball is hitting the net alot.  Looking at the micro, she suggested it was her shoulder.  Looking at the macro, the left side was tight, recruiting into the left oblique restricting motion in the right shoulder, aggravating the elbow.  After properly treating the problematic core muscles, she notices a marked improvement in the way her shoulder worked on the right side.  She should notice her power return during this weeks game and the ball will be going over the net. 
    The majic sauce in our approach is looking at you, not just the symptoms you arrived with.  We do this for you, your family, friends and co workers who are only aware of the elbow or body part hurting, and are likely visiting doctors who also see things that way. The only way to get a better diagnosis, and consequently, more cost effective and appropriate care is to get it right on diagnosis, which yields more appropriate care.  Things are rarely what they seem at first glance in the human body which is why I look beyond your symptoms and think about function. I also dig deeper and ask the right questions to uncover those valuable clues which help me solve the equation of why you hurt. Think of me as the Sherlock Holmes of the musculoskeletal system. My goal is to get it right the first time, fix your true mechanical problem and as many of our patients already know, a number of other chronic problems that are affiliated with that complaint go away too. 
     It is all about finding the cause and fixing that, and the symptoms and the future exacerbations are much less likely.  Its not majic, its getting healthcare right.

Running Shoes - Do they fit right and how to know?

Recent studies show that the cost of a running shoe does not assure satisfaction (http://www.nytimes.com/2010/10/23/health/23patient.html?_r=1&scp=1&sq=shoe%20fit&st=cse).  A recent article in the NY Times reports that athletes sometimes spend as little as $25 on shoes and are quite happy.  Although in my experience, a good middle of the line shoe (usually $80 - 120 retail), will give you great cushioning and support, you can often find that level of support in a less expensive shoe.  This may not work for everyone because not all feet are created equal, especially if they are flat.

The best and most advanced way to assure the best fit for a running shoe is to
1. follow my instructions on Howcast at http://www.howcast.com/videos/259469-How-To-Properly-Fit-a-Shoe.  Here are detailed instructions I published a while ago to make sure your shoes fit properly.
2.  Go to a running store with a treadmill - Stores like roadrunner sports or our local chain The Running Company can make the process more accurate.  You can see how you impact the ground using their treadmill and assure a better fit for your style of foot.  Different brands of shoes fit differently and sometimes the treadmill can save you money by helping you pick the right shoe for you.
3. If you have low arches or overpronated feet that flare out causing asymmetry in your gait, you can also use the treadmill to see the difference an insert makes.  Rather than buying a more expensive shoe that is stiffer and less comfortable, put in an insert and you will likely feel and run better.  Most stores will allow you to try them out.  I am personally unimpressed with some of the supposedly custom inserts some stores will upsell you.  Often, I find the less expensive off the shelf versions actually work better.  If you have a more severe foot problem, visit a professional such as a chiropractor or podiatrist and have custom inserts made. If done properly, they are more corrective and do last longer.

Cortisone - Does this cure make problems worse?

I recently came across and NY Times article which questions the wisdom of Cortisone Shots (http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/?scp=1&sq=cortisone&st=cse). Often when people are in pain, they are irritable and also impatient because of what the pain does to their normal daily activities.  The cortisone shot has been used for the quick fix for heel spurs, knee pain, shoulder pain, bursitis and other maladies.  It is usually administered by an orthopedist or a physiatrist.

The problem with this solution is that while it can cause a significant amount of relief, it will also cause bone loss and problems with healing at the site of injection if overused.  The other problem is that this injection will resolve the problem because the problem is that the area is painful.  This misunderstanding is natural since most people believe no pain, no problem.  Since inflammation rarely just happens, and it is usually due to a mechanical problem, it requires a mechanical solution.  Injecting an area that is inflamed, even though we do not understand why is not a mechanical solution.  It really is a shot in the dark, with the hope that it gets rid of the pain.  If you and/or your doctor have little understanding as to the mechanism of pain (hint; rarely is inflammation a mechanism however it is a response to unusual stress and irritation), you are likely to have the problem continue to reoccur and develop other related problems at other times and think these are also just pain.  The reality is, symptoms are just a warning that something is wrong.  Years later, that degenerated joint warned you about what is eventually coming down the road.

In our office, we look at symptoms, dig for facts and try to understand and the explain the mechanism of inflammation and then get to the mechanical cause.  The benefits of this approach are:
1. Real long lasting solutions.
2. Your joints are less likely to wear out because we are resolving the forces damaging the joint.
3. You are less likely to develop other related problems because the true cause has been resolved.
4. You enjoy a better quality of life and fewer doctors office visits with less pain.
5. You will rarely ever need a cortisone shot.

High level activity in older adults is very beneficial - I see this with many of our patients

I came across this article (http://www.investorplace.com/20701/physical-activity-beneficial-at-advanced-ages/) regarding patients who are older.  Apparently, older people who stay active and are most likely to have better vitality later in life into their 80's and beyond a new study shows.

We have many people in our practice family who stay active and many still compete athletically.  This compares with previous generations who were more sedentary and as they got older, developed many health conditions secondary to deconditioning.  Check out the article.  Very thought provoking

 

New Obamacare benefits begin today - These are good changes - check them out

According to Web md in their article published on line today (http://www.webmd.com/medicare/news/20100922/latest-round-of-health-reform-benefits-kicks-in), some of the new health care requirements kick in today.  These are good for Americans.

Highlights include

• Removing lifetime dollar limits on essential benefits
• Giving people a right to appeal to an external party if denied coverage for a treatment
• Preventing insurers from dropping coverage of people when they get sick
• Limiting the use of annual spending limits of health plans
• Allowing consumers to use ob-gyns in their networks without needing a referral
• Prohibiting extra charges for using emergency care that is out of network
• Guaranteeing full coverage of many preventive services, such as mammograms and colonoscopies, without a co-pay, co-insurance, or deductible

 These are wonderful for the public.  Personally, just the idea that preventative costly procedures such as colonoscopy will finally be more affordable is great, since many people are finding this preventative service is expensive and with many newer plans, often put off due to afford-ability because it costs thousands due to high .  Great news.

For many people with job-based coverage, the insurance changes will arrive Jan. 1, 2011, at the start of the new benefits year.


At the same time, the resistance is notching up. This week, as the consumer protections kick in, media reports have revealed that some major insurers, at least in part, will sidestep one new provision: denying coverage for children under age 19 who have pre-existing medical conditions.

Why anyone in government (you know who you are) would want to prevent this or repeal this is beyond me.

What do you think?  As always, I value your opinion.

Osteoporosis drugs causing fractures - another promise that does not add up

I was reading in the Star  Ledger about how the often prescribed osteoporosis drugs like Boneva and Fosamax have been found to create fractures (http://www.allvoices.com/contributed-news/6786125-osteoporosis-drugs-like-fosamax-and-boniva-linked-to-hip-fractures).

Years ago, we would spot osteoporosis on an x ray and it would tell us that certain people are prone to having possible problems with fractures.  Hip fractures in the elderly can be devastating.  Earlier generations in many ways were less active in retirement ( I remember my grandmother and her card games as activities vs. my parents who played tennis and go to the gym.).  We had less sophisticated tools to look at this such as x rays vs. our Dexxa Scanners that are much more sensitive to detecting early bone loss.  The drug companies worked on medications they could sell us as being preventative for bone loss when loss was occurring as per these very sensitive scanners and they sold doctors on the idea through their drug reps.  Many people now found their doctors managing their health by the numbers on the scan.  I have seen hundreds of people who  were placed on these drugs to prevent the yet disease (the one that did not happen or may never happen yet).  Many of our patients who went on these drugs promptly went off when the side effects hit.  I am sure these numbers are underreported.

The bottom line is that this is clearly interventional, not preventative and dispite the billions made by the drug companies on this supposedly preventative health regimen, in the end, it is side effects, over doctoring and then having pecuilar types of fractures that may not have occurred if you were not on the drug.

I have a better protocol; Stay active, eat right and play the odds (very few people actually have problems related to osteoporosis when considering the entire populace)  In other words, leave it alone.

What do you think?  As always, I value your opinion

USATF evaluates if stretching prevents running injuries - Science says it doesn't, their study agrees and more

Yesterday, the NY times reported on a study performed by USA Track and Field, the organization that credentials the race's and many of the running events throughout NJ (http://well.blogs.nytimes.com/2010/09/01/phys-ed-does-stretching-before-running-prevent-injuries/)

I have been working with runners and have been involved with USATF in NJ and I have always maintained that stretching does not prevent injuries.  For years, stretching had been the gold standard and even today, many running coaches who were brought up with this concept continue to teach stretching to their new and developing athletes.

Years ago, when I was in chiropractic college in Illinois, a company called SPRI who performed rehab and  the owners, Richard Dominguez, Robert J Gajda, wrote about their methods in a book entitled Total Body Training.  The book, written in the 80's told about how exercises rather than stretching gets the best performance out of athletes.  SPRI now produces tubing kits for exercise as well as other products.  Many other studies have also shown that stretching has little benefit and now the USATF study also shows that those who stretch and those who do not have about the same amount of injuries.

An interesting note in all this is that those who were used to stretching and then stopped had an increase in the amount of injuries that had the endure.

Looking past the surface of this, there is a benefit to stretching which is in young and developing children.  As bones grow, so do muscles in response to that growth.  Stretching during those young years will yield greater flexibility in adulthood which is why I will never be able to perform a split while my daughter who has done gymnastics since she was 4 years old can.

When we look at the motivation of stretching which is injury avoidance, I believe those who did it regularly and then stopped and experienced more problems had bio-mechanical issues which likely were never properly identified.  In our office, patients find out that it is firing patterns, myofascia and muscular coordination of movement which actually are the reasons for tightness.  Once these issues are properly addressed, the person tightens much less, has much greater flexibility and their overall gait improves.  The more efficiently they move, the more flexible they are and the fewer injuries they sustain.  The discussion should not be about weather or not to stretch.  The argument is about body mechanics and its relationship to injuries in runners.

What do you think?  As always, I value your opinion

Doctors are seeking new ways to prevent muscle loss - buyer beware..

I was reading an article today published by the NY Times regarding aging and muscle loss (http://www.nytimes.com/2010/08/31/health/research/31muscle.html).  As people age, it is presumed that we lose muscle tone and strength due to many factors such as activity, fatty infiltration in the muscles, hormonal changes and they have even created a new medical term for this called sarcopenia, a fancy medical way of saying muscle loss.  The concept is patterned after the idea of osteopenia, which is a loss of bone in medical terminology.


I say buyer beware because drug companies would love to bottle this and sell this as the next life threatening malady that afflicts us which can be bottled, and then sold, side effects and all with the blessing of insurance companies who become convienced this is a true malady that is life threatening.  


The reality is that people need to remain active and stimulated.  People who work into their late 70's and 80's tend to be sharper mentally and physically, they move better although we have the problems of gravity, our body mechanics, degenerative changes in the spine leading to spinal stenosis which will cause muscular wasting (you cannot solve that in a pill) and there are of course, degenerative processes due to hormonal changes and also changes at the cellular level which are likely not to be helped by a pill.


My solutions are for people to have more active lives (many people are overweight and less active - a problem the army is experiencing with new recruits), to eat better (lets get away from our unhealthy food production methods and corn doping of many things we eventually eat) and to take care of biomechanical problems when we are young (true preventative care).  Trying to give someone a pill for a problem that in most cases is because biomechanical issues have been ignored for years because doctors did not understand them is absurd, and will also likely if history repeats itself will be expemsive and give us problems we dont have and are not likely to develop without the pharmaceutical companies help.


We need to embrace aging as a normal process, not a disease and people will have healthier muscles with a properly functioning body, and myofascial system, rather than the next pill to fix a problem that is a natural part of aging, given that most health care practitioners really do not understand human body mechanics very well.

What do you think?  As always, I value your opinion.

Parents in NJ are finding reasons to forgo vaccinations. Food for thought

I was reading in the NJ Star Ledger about the below average rates of vaccination in NJ children (http://articles.moneycentral.msn.com/news/article.aspx?feed=AP&date=20100822&id=11932980).  Like many of our patients, my children have received vaccinations and although on the surface this regular medical service that is part of our preventative healthcare and supported by the CDC.  Even in a state thought to be as affluent, and educated as in NJ, many middle and upper class parents are forgoing vaccinations because in many cases, based on some of the concerns in the media regarding the link between autism and mercury that is used in the vaccines may be harming their children.  I must admit, I still wonder weather my sons aspergers syndrome was linked to vaccines.  I will likely never know but I cannot go back in time, avoid vaccinations and then see how he turned out.  I just does not work that way.

Recently, there have been reports that whooping cough may be returning to our population, even though that population has largely been vaccinated.  Could it be that vaccinations are over hyped, religiously pursued by the NJ legislature because of the medical lobby as well as pursued by drug companies trying to cash in on the next flu scare (remember swine flu, H1N1) (http://www.chetday.com/fluscaregame.htm).  Our memories are as short as the media but someone made a ton of money scaring the public into getting vaccinated against the maybe disease.  In the case of H1N1, our government spent a ton of money, the public did not receive this scare with open arms and they were left with tons of expiring vaccines that were not worth the bottles they were printed on. What is a scare weary public to do?

The thing that really scares me is that one day, when we have a real scare, few people will listen and the chicken little effect will occur (few people will believe it when the sky really is falling). I think that day is nearing and NJ vaccination rates are a symptom of that malaise.

We really need to rethink many of our health policies, since they often amount to scare tactics with little or no health benefit and in many cases, side effects (cholesterol lowering drugs anyone).  Somehow, people in other countries have a healthier outlook without having all the stuff done to them. With regard to vaccines, this blog post is not designed to help someone decide weather or not to vaccinate their children.  People should read and make their own opinions, rather than have it written into law that they must do this.   It is true that some people have vaccine reactions (although a small sampling of the populace) and have neurological impairment or other problems as a result.  Somehow, our society has made these risks acceptable even though much of our immunity to many diseases is natural (natural immunity still occurs believe it or not without vaccines) and natural immunity occurs by reacting to the infection.

What would happen if we decided tomorrow that vaccines are no longer mandatory?  Would the masses avoid them in droves?  My opinion is that it depends on what you believe.  The only true way of finding out if vaccination is unnecessary is for the populace to avoid it.  It would take many years to see if we need it or if the diseases we have tried to prevent come back or if our improvements in sanitation and living standards are really the reason we no longer see many of the diseases we vaccinate for.

What do you think?  As always, I value your opinion.

Repeat athletic injuries - Should we change our way of competing or are we missing something.

I was reading today an article in the NY Times concerning athletic injuries in aging athletes (http://www.nytimes.com/2010/08/17/health/nutrition/17best.html?8dpc).  A thoughtful article, although I am surprised they did not ask the opinion of a non medical style provider.  Is being an overachiever athletically a psychological problem?

I have been treating older athletes for years.  It is always sad when an athlete has numerous injuries that are termed as overuse and then gives up the sport they love because the injuries continue to pile up.  I too injured my back playing softball this season and I am likely not to return.

Many athletes we treat have chronic problems because they are misunderstood.  Stress fractures, knee pain, hip pain, shoulder problems are often looked at as separate entities.  The reality is that they are usually part of a gait related issue, causing the person to slam their foot into the ground. It is my experience that most health care providers are trained to look at the pain, name and diagnose the condition and then treat it or put the person on rest for a while then send them back into the wild.  The problem is, without understanding the true cause, the next injury occurs, then the next and then the person eventually gives up after years of trying to fight through the eventual outcome of giving up.

A better idea is to understand the mechanism of the painful problem, name it functionally vs. using the typical dis ease monicre of itis, osis, tear, stress fracture and realize that functional problems require a functional solution which may include orthotics, gait retraining and other ideas.  Most often, these people will likely return to activity and back to the sports they love with far fewer injuries.  With the old way of thinking, they may require surgery, joint replacement and other interventions because the doctors were not trained to evaluate why the injuries occurred.  Athletes of all ages deserve better.  We should never treat or name anything we truly do not understand.  Athletes should not suffer because their health care providers do not understand why they hurt.  They joint replacement manufacturers will likely not enjoy this blog post however, if you are an aging athlete, for you it will.

What do you think.  As always, I value your opinions.

Survey shows majority who utilize chiropractic care for their low back pain report "a great deal" of benefit.

By Peter W. Crownfield, Executive Editor of Dynamic Chirorpactic The past 12 months have been good - very good - for the chiropractic profession in terms of data supporting the efficacy of chiropractic care. For starters, consider the Wellmark pilot study that suggests chiropractic reduces both costs and need for surgery;1 the Milliman USA analysis that concludes, "[S]pinal patients who seek chiropractic coverage have materially lower health care costs than those who do not";2 the Consumer Reports reader survey that found "hands-on" therapies, led by chiropractic care, were the top-rated treatments for back pain sufferers, with chiropractic receiving the highest satisfaction-with-care ratings (significantly higher than MDs);3 the "Mercer Report" that suggests chiropractic compares favorably to most therapies covered by health benefit plans and is "likely to achieve equal or better health outcomes";4 and the final report on the Medicare demonstration project, which notes that 87 percent of patients surveyed gave their DC a satisfaction score of 8 or higher and 56 percent gave a perfect 10.5 The latest thumbs-up comes courtesy of a survey analysis published in the June 2010 issue of the Journal of the American Board of Family Medicine.6 The analysis, based on data from the 2002 National Health Interview Survey, revealed that 60 percent of U.S. adults utilizing CAM therapies for back pain reported "a great deal" of benefit. Chiropractic was used most frequently (74 percent of respondents) and had the highest success rate (66 percent reporting significant benefit). The analysis evaluated utilization of six CAM modalities: chiropractic, acupuncture, massage, relaxation techniques, herbal therapy, and yoga / tai chi / qigong. Sixty-nine percent used one therapy only, 21 percent used two, 8 percent used three, 1 percent used four and less than 1 percent used five or more therapies. Massage was a distant second in terms of patient use for back pain (22 percent of respondents reporting use) and perceived benefit (56 percent reporting "a great deal" of benefit for their back pain). The percentage of respondents perceiving similar benefit for the other CAM therapies was as follows: 56 percent for yoga / tai chi / qigong; 42 percent for acupuncture; 32 percent for herbal therapies; and 28 percent for relaxation techniques. Two factors were independently associated with greater perceived benefit from CAM use for back pain: better self-reported health status and an indication that "conventional medical treatment would not help." The factor most associated with less benefit from CAM for back pain was "referral by a conventional practitioner." The authors of the survey analysis speculate that more or less perceived benefit may be attributable to several factors, including that an independent decision to utilize CAM (rather than being referred) may increase perceived benefit, while referred patients may have pain that is less responsive to treatment (contributing to less perceived benefit). What is not discussed is whether data is available on the professional usage patterns for those who self-referred vs. those referred by a medical provider. If those who self-referred chose different providers than those referred by an MD, it could have impacted perceived benefit with care, particularly the reduced benefit perceived by those referred by an MD. If there is a difference, and it can be shown that it did impact perceived benefit, it suggests that MDs need to have a better understanding of which CAM providers to refer to for back pain. Given that chiropractic continues to have the highest level of patient satisfaction, MDs who choose other CAM providers would want to ensure that they are not making that choice based on false assumptions. This difference also might ultimately lead to more specific referral criteria for MDs referring to CAM providers for back pain. References "Study Suggests Chiropractic Reduces Health Care Costs, Need for Surgery." Dynamic Chiropractic, Aug. 26, 2009. "Cost-Effective Care: The Evidence Mounts." Dynamic Chiropractic, Sept. 9, 2009. "Consumer Reports Survey Rates DCs Higher Than MDs." Dynamic Chiropractic, May 20, 2009. "How Chiropractic Helps the Insurance Industry." Dynamic Chiropractic, Dec. 2, 2009. "Medicare Patients Give Chiropractic High Marks." Dynamic Chiropractic, March 26, 2010. Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med 2010;23:354-62. Source: dynamicchiropractic.com

Economy Led to Cuts in Use of Health Care - what do we make of this?

I read an article today that stated that a study done by the  National Bureau of Economic Research says that the recession reduced the utilization of health care services, across the board (http://www.nytimes.com/2010/08/17/health/policy/17health.html?_r=1).  They compared our country to others with lower out of pocket costs and found that the higher out of pocket expenses contributed to the reduction of utilization.

Our office experienced this as well over the past 3-4 years.  I am aware of a recovery taking place since May of 2009 when business in our office picked up. Part of it was pent up demand and the other part of it is likely people coming to terms that higher copayments are here to stay and they are probably used to it by now.

I am troubled by this data for a few reasons:
1. There were fewer doctor visits and therefore fewer procedures done, yet, the overall health of the nation has not been compromised.  One would wonder that perhaps, many recommendations for tests and procedures may not be needed after all and are part of the problem.  In other words, people can be left alone, with fewer interventions which does not appear to affect life expectancy.  I hope the authors are looking at their data more closely now, and looking past the obvious.  In other words, do we need to lean on the health care system as much as we are advised to do if there is no real benefit, or possible detrimental effect of procedures and tests that just are not necessary?

2. Higher co payments means insurance companies paid out less and consumers were expected to pay more. Since we also used our doctors less and had fewer procedures, why did rates increase an average of 20 percent this year for many of us, yet there is evidence that medical inflation this year has almost come to a halt?  In other words, why the increase and who is benefiting (hint: its not the doctors and we personally were hit for another 18 percent on chiropractic fees by Aetna again)? In my opinion, health care reform did not go far enough and should have included a public option.  This would have prevented these increases which make our country less competitive in the world economy because of the ridiculous cost of health insurance.

3. Over the last year, chiropractic utilization is up markedly.  Perhaps, people are shifting their spending habits to a more cost effective and overall effective type of care.  It costs less to get problems taken care of the right way, regardless of the visit costs.  In other words, in our office treats a person with shoulder and neck pain.  Doctor A before us evaluates the neck and shoulder, sends the patient for 2 months of rehab and orders an MRI, the problem returns two months later.  The cost - Thousands of dollars for a non solution.  The patient visits us Doctor B.  We find out during the evaluation the person has right foot flare on the side of shoulder pain and his hip flexor is pulling the shoulder forward causing neck and shoulder pain.  The problem resolves in 12 visits and the person purchases foot orthotics and is now aware of why the problem exists.  The costs, slightly over $1000 but the person has to put our $40 per visit because of an outrageously high copayment which is not compatable with rehab.  The person shoulders much of the costs but is pain free with money well spent and we got it right the first time.  The lesson is that it is not the cost of the visit, or the amount of stuff that is done to someone.  It is the quality of the health care experience that counts.  Getting it right and improving the persons health for years to come is always better than having tests and procedures.  Perhaps, this study also is a reflection of market forces which have been largely absent from our monopolized healthcare system.

What do you think?  As always, I value your opinion.

Was Atkins right, new study shows low carb diets are better for you

Todays NJ Star ledger had an article talking about the benefits of low carbohydrate diets vs. the calorie restriction traditional type (http://www.washingtonpost.com/wp-dyn/content/article/2010/08/02/AR2010080204125.html) . Truth be told, low carbohydrate diets lead to healthier people with higher levels of HDL's as the study shows. As with politics, companies who have diets also have pundits who will spin and twist diets benefits, without real world proof.  I have always told patients that if you wish to lose weight quickly, cut your carbohydrate intake in half and you will likely drop some weight without working too hard at it.  I have gone on many diets by doing just that: lowering my carbohydrate intake.  The most offensive complex carbs (http://www.weightlossforall.com/complex-carbs.htm) are breads and pasta's because they are filling, satisfying however, easily converted to sugar by the body.  Simple carbs include sugar itself (http://www.weightlossforall.com/simple-carbs.htm), soft drinks, fruits.  Please check out these links because they will give you a better and more complete list of these products.

Atkins (http://www.weightlossforall.com/atkins%20low%20carb%20diet.htm) was persecuted for his beliefs in the low or no carb approach.  Low carbs has been vindicated in this current study.  I typically look at food as fuel since my job is quite physical.  Carbohydrates such as cookies can be addictive and for many, their dietary downfall is through snacks which are carb heavy.  I usually recommend increasing protein and decreasing carbs for a healthier diet.  Carbs are often cheap fillers.  If you go to any buffet, you will find food loaded with carbs at an affordable price.  These places are a minefield for those who are not food savvy.  You can, on the other hand do quite well at many of these by sticking with the salads, meats, cheeses and minimize the pastas, rices and other grains including the breads which cost less and people fill up on.

What do you think?  As always, I value your opinion

Health care by numbers, putting healthy people at risk

I was speaking to a patient today who was having some muscular problems and was concerned about.  He had just had his creatine levels checked (http://ezinearticles.com/?Creatine-Levels&id=405381) and the level was high.  Creatine levels that are high with cholesterol lowering drugs injestion is one of the reasons we need to be checked frequently when on these meds. I also suggested that some of his muscle stiffness and problems could be due to the drug.  When I asked him why he was having the problem, he said that his heart had a problematic valve which has likely been there all his life. When I asked him about his cholesterol levels, it was well under 200 which really is not high.

The important question is this:  Does the benefit outweigh the risk?  The patient has a known problem that is probably developmental.  Decreasing cholesterol levels that are near normal has no effect on heart function.  Taking cholesterol meds 5 times per week puts him at risk for liver and muscular problems, as well as adding medical costs to monitor him.  Since we are looking at a what if scenario which scares people because nobody wants a heart attack or a blockage to create a life threatening, what if we did nothing?  What if he got hit by a car tomorrow?

I know that is ridiculous but giving a perfectly healthy person dangerous (http://www.thepeopleschemist.com/view_learning.php?learning_id=11)  meds that potentially create problems he never would have had with constant monitoring makes little sense to me.  It is not preventative care, and has a detrimental effect, rather than a benefit over the short term. True preventative care prevents known outcomes such as foot problems creating back problems for instance, since it is mechanical and easily identifiable.  Shadow boxing with what if scenarios by physicians for dubious prevention of rare events is bad medicine.  Taking potentially harmful cholesterol lowering drugs that are likely to have no benefit but cause problems you do not have is not preventative, its foolish and a bad way to spend our health care dollars. Statistics show that statin's have a very small effect on extending ones life (http://www.dailymail.co.uk/health/article-432395/Statins-truth.html), and their benefits are way overstated. The best doctors question everything, including some of the practices of their own profession.  I have certainly done this as a chiropractor.  If you are a person who is on statins and has naturally low levels of cholesterol, but were advised these meds are a good idea, think about this article, the resources in it and have a fair and honest discussion with your doctor.  It is never about your doctors practice style, it is about your health and knowing the difference between prevention and an intervention that is good for your health vs. one that is not good for it.

What do you think, I value your opinion.

Can sitting shorten your life? A new study suggests it will.

I read an article today regarding sitting and how it can shorten your life (http://www.usatoday.com/news/health/2010-07-27-sitting-death_N.htm) .  In a 14 year study, they found that people who sit for longer periods of time (many of us do this at work for hours) are more likely to die from heart disease than those who get up and move around alot. Apparently, mixing alittle exercise with sitting did little to change the outcome.  Apparently, there was a sedentary physiology that develops with those who sit alot.  Please read the article.  Very interesting.

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business because or the perceived reputation that ASHN had. I was not thrilled, since two years previous, I had helped save Cigna's previous HMO network who was also hurting chiropractors financially by underfunding a capitated plan and not communicating with Cigna that a problem existed.  Cigna historically likes to use vendors instead of administrating certain professions such as chiropractors directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago,A Cigna representative convinced us to join their Open Access Plus networks as well which we joined under the condition that we did not have do deal with ASHN.  Cigna's management under Open Access Plus and PPO plans was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well for the past few years.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare because Cigna now said that we can only continue our participation by joining the network.  Some of my colleagues were exiting the network as I was credentialing however, I was willing to give it 6 months to try the network out.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair but conservative. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna directly did not require any paperwork.  In other words, things would not change other than who we bill through.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  We were told to fill it out after the 5th. After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also then found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we had been lied to or deliberately misinformed.  This meant we now had to scramble to do precertification paperwork on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and they either denied increased treatment past 5 visits or gave us visits but reduced time frames that we billed within.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said I was and then he could not believe we were misinformed by their staff,  offering little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were paid before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right. It also is not right for an employer who to buys benefits that are advertised for up to 60 per year to have their employees find out it is limited it to 6 or 7. Bait and switch plans are not ethical.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN. For anyone else reading my blog, including other doctors in my profession, I am not suggesting any course of action, however, if your experience is similar to mine, you will have some thinking to do.

Was leaving the right thing to do?  I believe it was.  Working harder for less reimbursement and cheating patients out of their benefits was not what I signed up for.  In my office, it is quality or nothing.  In the case of the Cigna plans, I would rather be out of network where quality can exist. What do you think?  I value your input.

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business.  Cigna historically likes to use vendors instead of administrating particular professions directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago, their representative convinced us to join their Open Access Plus networks as well.  Cigna's management was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare.  Some of them were exiting the network as I was credentialing however, I was willing to give it 6 months.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna did not require any certifications.  In other words, things would not change other than who we bill to.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we have been lied to or deliberately misinformed.  This meant we now had to scramble to do precerts on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and many of them did not give us what we needed, or ended care prematurely either by visit or by date.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said he was and then he could not believe we were misinformed by their staff, and offered little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right.It also is not right for a company to buy benefits that are advertised for up to 60 per year and limit it to 6 or 7 and then tell the patient sorry, while I need to fan the flames of someone who was sold a bait and switch plan.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN.

Was leaving the right thing to do?  I believe it was.  Working harder for less reimbursement and cheating patients out of their benefits was not what I signed up for.  What do you think?  I value your input.

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business.  Cigna historically likes to use vendors instead of administrating particular professions directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago, their representative convinced us to join their Open Access Plus networks as well.  Cigna's management was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare.  Some of them were exiting the network as I was credentialing however, I was willing to give it 6 months.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna did not require any certifications.  In other words, things would not change other than who we bill to.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we have been lied to or deliberately misinformed.  This meant we now had to scramble to do precerts on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and many of them did not give us what we needed, or ended care prematurely either by visit or by date.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said he was and then he could not believe we were misinformed by their staff, and offered little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right.It also is not right for a company to buy benefits that are advertised for up to 60 per year and limit it to 6 or 7 and then tell the patient sorry, while I need to fan the flames of someone who was sold a bait and switch plan.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN.

Sincerely,

William D Charschan DC,CCSP .

 

Right to die with dignity - NJ sees a new billboard campaign

I read an article the other day about right to die groups and how they are getting out their message (http://www.nj.com/news/index.ssf/2010/07/national_campaign_guiding_ill.html).  Apparently, there are many groups that are taking Dr. Kevorkians message and putting their own spin on people being able to be allowed to die if the conditions warrant it.  In my opinion, many people die in hospitals, with tubes out their body in misery.  There have been many instances where these same people have been given an overdose of a medication to put them out of their misery, however, this is considered illegal.  I agree that is someone is terminal, and miserable, and has an extremely poor quality of life, they should have the option to end it.  Many religions oppose this because the value of life is too great.  In reality, many of these religions have been around for thousands of generations, long before we had the equipment to keep the near dead alive.  Statistics show that we consume at least 1/3 of all our health care costs at the end of life, with the end being the same.  When did it become ethical to torture the dying?  We not only torture them, but we drain them and their family financially, emotionally, without having a rational alternative unless a living will is present. The outcome, statistics show is the same;  death, which is a normal part of our lifecycle.  We should educate ourselves about how to prepare and take a healthier view during the emotional end of a loved one, rather than try things that decrease the quality of life at the end and worsen the suffering.

Without being morbid, I do believe in advanced directives, and I believe it is wrong to keep dying people alive artificially, to prolong their suffering.  We surely do not usually do this with our pets who may die with more dignity when the terminally ill pet is put to sleep painlessly. 

These groups have a valid point.  We should have the option if we are terminal and have poor quality of life to end our own suffering. That is my opinion because it is humane.  Regarding the use of billboards, this makes a big statement.  Sometimes these types of statements are offensive however, often if you have not offended someone, you really did not get your point across effectively.  BTW, the ensuing articles published by the newspaper on these signs is great marketing and PR.

What to you think? I always value your opinion.

Dr C

Dis ease - the idea of diseases as the cause of what ails us

Wikipedia describes disease as follows:

A disease is an abnormal condition of the body of organism that is not comfortable for it. It is often construed to be a medical condition associated with specific symptoms andsigns.^[1][2][3] It may be caused by external factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune diseases.

In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections. Isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. A diseased body is quite often not only because of some dysfunction of a particular organ but can also be because of a state of mind of the affected person who is not at ease with a particular state of its body.

Our health care system is built upon the concept and the Merck Manual, a commonly used guide for diseases is used by doctors worldwide.  Disease is regularly used in languages throughout the world and in many cultures, since this is the way we are used to describing a series of symptoms, sometimes with a known cause of pathogen, or sometimes it is just a series of symptoms, named after someone that they described as a new disease or ailment that afflicts us, as well as most living things.  Disease has also been used by drug companies to sell product (eg: seasonal effective disorder, restless leg syndrome).  

In the chiropractic world, using this definition, back problems can be classified as diseases too, however, this is because it is dis  ease or as described above it is a medical condition of specific symptoms of signs.  The problem I have with this is that often, using the term disease describes an affliction, without promoting understanding.  Too often, diseases have been treated with medications to relieve the dis ease, without understanding why the problem exists.  Knee problems are a perfect example of this. We diagnosed meniscus disease, kneecap tracking disease which in no way describes what the condition is or how it got there.  We have trained people to treat these dis eases who could care less why it went bad.  The reason it went bad is the problem.  We teach them to throw therapies and solutions at the symptom which is knee pain which leads to tests and interventions, without the understanding of what we are treating. In the realm of musculoskeletal medicine, this is problematic, expensive, can be disabling (knee replacements gone bad with their thousands of dollars in implementation and rehab.  What the dis ease moniker does not do is promote understanding.  Lack of understanding currently leads to tests, questionable interventions and expensive solutions of limited benefit (knee replacements, which my mother had just undergone can last 10-15 years and then need to be redone). A better paradigm which is functionally based, rather than dis ease classified would lead to better prevention of many of the so called dis eases. Of course, there are many entities in our healthcare system who are profiting handsomely from the dis ease philosophy being used in the musculoskeletal system.  It has lead to unbelievable high costs of treatment, mediocre rehab based on a paradigm that is not meant to promote understanding , unneeded testing and human misery.  Managed care promised to hold the line on these costs but instead has tried to clear a profit without helping the paradigm change to a functionally correct one.  As they have failed, like the government, they simply pass the bill on to us as higher insurance premiums which has lead to more people underinsured with higher out of pocket costs and a health care system very far from cost effective and effective when compared to the rest of the world.

My recommendation is that at least in the musculoskeletal realm, we move away from the dis ease idea and move toward one of function, which will yield to lower costs from better care and more effective treatment and better preventative care.  Other diseases should come under the microscope too since we try to classify things we really do not understand into bite size pieces and then throw therapy regimens about the symptoms so the dis ease process is no longer noticed (not necessarily resolved).

Christian Medical Bill Sharing and other ideas for health coverage

I came across this article on something called Christian Medical Bill Sharing (http://www.walletpop.com/blog/2010/06/24/christian-medical-bill-sharing-a-growin/).  The catch to this that you need to be Christian, adhere to Christian values for coverage (they do not cover abortions, sexually transmitted diseases which are considered un Christian like behavior) however, the premiums are considerably lower than traditional insurance.  Members like the plans because as long as they stay within the PPO network, they have a low co payment and it covers their needs.  Of course, there are going to be critics of plans like these, however, as people look for more affordable types of coverage, or are displaced from their current employment or start their own businesses, the cost of insuring you and your family can be a deal breaker (Many average plans can cost 16 thousand dollars for an average plan and just ok coverage).

The big idea here is everyone shares everyone else's health care needs for the greater good, a very Christian ethic.  Ethics seems to be a problem everywhere we look so an ethical type of healthcare plan with a strong belief system behind it that practices what it preaches is a good idea.  They also work with people to help them maintain a healthier lifestyle, a paradigm that has been abused in todays society and health insurance plans.  I can get into the healthier lifestyle area however, that is an entirely longer discussion since it encompasses what we eat, processed foods, the government helping corn growers with subsidies for corn syrup and other unhealthy foods rather than helping to keep the cost of good quality food affordable so even the poor can easily buy it and live healthier lifestyles.

I am currently shopping for new health insurance and quite honestly, the price increases over the past year have been incredible.  Also incredible, is Aetna just decreased our reimbursements for chiropractic services again (something they have done every few years) by up to 18 percent, yet their rates are some of the highest I was quoted.  Where is this money going if it does not go to providers who are already cash strapped by greedy insurance companies who have done this repeately over the years.  Unlike this shared plan idea, insurance companies, and their focus on bottom line and CEO bonuses in the millions is very un Christian like especially when they deny medically necessary care by a reviewer you cannot communicate with other than appeal letters which often go nowhere, especially with self insured plans that are administrated by plans like Aetna.

Ethical shared health care - perhaps this is an idea we need to explore not just in the Christian communities but for other people like myself, a Jewish doc trying to help people live a better quality of life.

What do you think?  I value your opinion

Salt and Heart Health - Know what you are eating and what is in your prepackaged food

I read an article that was reprinted in the Star Ledger today from Bloomberg News (http://www.bloomberg.com/news/2010-06-24/potato-chips-help-drive-up-salt-intake-for-most-american-adults-cdc-says.html) regarding problems in the american diet.  The Centers For Disease Control is sharing their concerns about food and the amount of sodium used in it.  Many junk foods such as potato chips are laden with salt, way to much for our bodies needs.  More salt means more electrolytes which means your body will retain water which means it can have an effect on blood pressure.  Many of the pre packaged foods we eat are flavor deficient and salt is used to get them to have flavor.  Many restaurants use salt, sometimes in abundance with soups and other dishes to give it flavor.  Better restaurants find foods that mesh well together and therefore do not require too much salt.

Lets face it, many of use like salt however, often less can add more.  Many times I have pushed away soup in a diner because of the salty taste.  It really is overkill and our health may suffer long term for this.  The answer is not your doctor or the blood pressure medication to control this.  The answer is for the public to refuse to eat food that has exorbitant amounts of salt.  You can check the packages and if the salt levels are way too high, dont buy that food.  French fries if they are really good and flavorful need minimal salt (as opposed to what Mcdonalds sells)

The solution really is public awareness, changing tastes (corporations will make that the public will buy) and a willingness to change.  This will be better for our health and should affect health care costs nationally if we make salt reduction a national priority.

What to you think.  I value your opinion.

Pressure on doctor pushes up costs, or does it

I was reading the opinion column in todays NJ Star Ledger regarding an article written by Stella Fitzgibbons MD, who is a hospital based board certified doctor in the Houston Area (http://articles.latimes.com/2010/jun/17/opinion/la-oe-fitzgibbons-health-costs-20100617).  She talks about her experiences and who health cost containment is difficult leading to unnecessary testing.  Apparently, many families pressure doctors to run many tests to rule out rare problems which the doctors experience had shown will respond well without the increase testing and intervention.  She mentions other sources such as web sites and magazines which tell the patient to literally bully the doctor into doing certain procedures and tests.

From the health care providers perspective,  what she has said is true from her unique perspective, however, people make many health decisions based on emotions and fear.  Fear is a great motivator and our healthcare system has used and in some cases abused this to push patients into doing things they may never have done to themselves, sometimes with horrible and disfiguring effects. People have also been talked into taking harmful substances they would never have taken with horrible side effects because of the false hope they saw on television or the education their doctor received from the local drug rep convincing the doctor that this medication was indeed good for their patient.

When people come to the hospital with symptoms they do not understand, fear is ever present and rational thinking often is scarce, especially around caring family members who found their distressed family member. Our broken healthcare paradigm has literally brainwashed the american public to expect all these tests  to leave no stone unturned even though a good exam and responsible recommendations are enough to stay within community standards of their medical specialty, which would protect them from malpractice lawsuits.   .

There are not clear protocol recommendations for patients who enter the ER which eliminate the unnecessary use of diagnostic technologies giving families and the one who is ill a greater sense of confidence with the healthcare provider.  The system is actually set up for people to want more because of the perception that more is better and the legal perception if liability if every last thing should be tested, even though in many cultures, it is not and people are in many instances are better off.  A better system that would save costs, suffering and over testing would be one that would force  the doctor to do certain protocols first. Then the patient has to wait a few days after following their home recommendations before further tests are done as they follow up with their own doctors.  This would make sense and eliminate some unnecessary testing but not all.  I doubt that would happen though because some lobbyist would likely call this rationing, some attorney would call it malpractice (which  they cannot if the doctor follows community guidelines which is the way the average doctor in that specialty would behave) and would get the public in an uproar by using the appropriate buzz words.

 Is it rational to steer patients down the most logical path based on the current science we have available?  I believe it is and our healthcare systems can certainly help patients better with more rational and concise  recommendations that take the patient and their families emotions out of the decisions.

In another case she mentions, she has a patient who just came into the IC unit after a huge stroke.  She mentions that the family wants everything done to save the life of someone who is also in kidney failure and also has pneumonia.  Again, failure of having concise protocols has the family making emotional demands that will prolong his suffering, are likely to fail on an individual with insufferable brain damage.  The outcome with or without tubes and procedures is the same - the loss of a loved one.  Our healthcare system needs to be able to council a family on the right thing to do which is prepare the patient and their family for the inevitable, rather than having these stressed and scared people make a decision they are likely unqualified to make in the situation that presents itself.  The loss of a loved one is awful, and we do not want to let go.  If the outcome is the same, and comfort rather than intervention is more humane, yields the same results and does not totally drain the persons bank account as well, shouldn't the best course of treatment be a protocol that leads the family down the right path, rather than giving them the right to push for intervention which clearly is wrong.
Some may say that this takes away freedom of choice and is rationing.  I call it rational health care policy.  As many studies are finding out, often less is more which is especially true in healthcare.  Many developed countries do more with less and the care is often excellent.  Their understanding on life, death and taking care of oneself is healthier as well (our country is #38 in the WHO for health care quality).  Yes, we americans can  learn from other countries healthcare systems and we should.

In life, we are born, we live our lives and at a certain time, our bodies will fail, while we used our lives to procreate and create our legacies.  Disney called this the great circle of life.  Disney had it right, perhaps our medical systems should learn from Disney. Its as simple as that!

What do you think.  I value your opinions.